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Do A‐waves help predict intravenous immunoglobulin response in multifocal motor neuropathy without block?
Author(s) -
Lange Dale J.,
Nijjar Rajwinder,
Voustianiouk Andrei,
Seidel Gregory,
Panchal Janki,
Wang Annabel K.
Publication year - 2011
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/mus.21914
Subject(s) - amyotrophic lateral sclerosis , medicine , multifocal motor neuropathy , grip strength , electrophysiology , motor unit , cardiology , motor neuron , anesthesia , physical medicine and rehabilitation , physical therapy , disease , electroencephalography , anatomy , mismatch negativity , psychiatry
Are there electrophysiological findings that predict response to intravenous immunoglobulin (IVIg) in patients with lower motor neuron (LMN) syndromes without multifocal conduction block (MCB)? Methods: We enrolled 9 patients with LMN syndromes without MCB to receive 18 weeks of IVIg therapy. Response was measured at weeks 2 and 18 using the Appel Amyotrophic Lateral Sclerosis (AALS) score (includes grip and pincer strength measures), ALS Functional Rating Scale (ALSFRS), and electrophysiological measures, including motor unit estimates (MUNEs). Results: No change occurred in AALS or ALSFRS scores posttreatment. Grip/pincer strength increased in 7 patients ( P = 0.028) after initial treatment (responders); 2 showed no improvement (non‐responders). No electrophysiological measure changed after treatment in either group but MUNEs trended higher ( P = 0.055). “Abnormal A‐waves” (complex, repetitive biphasic, or present in multiple nerves) occurred in pretreatment studies more often in responders ( P = 0.028). Discussion: “Abnormal A‐waves” may signal IVIg‐responsive LMN syndromes even if conduction block is absent. Muscle Nerve, 2011